MEDICAL

THERAPY

PROGRAM “ P U T T I N G T H E P I E C E S T O G E T H E R ”

CALIFORNIA CHILDREN SERVICES

CCS is a statewide program providing medical care and

rehabilitation to children with physical disabilities. CCS

provides medical case management and financial assistance

to children who qualify for the program.

The therapy program is one integral part of the overall CCS

program that provides physical and occupational therapy

services to medically eligible children. This part of the program

provides direct service.

WHAT IS A MEDICAL THERAPY UNIT (MTU)?

An MTU is space where physical and occupational,therapy are provided on the grounds of a public school.

WHAT ARE THE GOALS OF THE MTP?

To see the child achieve the

highest level of

independence in functional

skills.

To train the family,

caregivers, and educators

WHAT IS THE REFERRAL PROCESS?

• Anyone can refer a child

with a presumptively

eligible condition.

• Physicians, education,

agencies, PHN’s, parents.

• Only the parent or legal

guardian may apply and

consent to services.

.

HOW ARE REFERRALS SUBMITTED?

• Physicians --a Service Authorization Request for

therapy or specifically for MTP Services.

• Schools --submit an LEA/SELPA referral packet

ensuring communication between the school district

and the MTU.

Parents -- call CCS Central Office

WHO IS ELIGIBLE?

• Age: birth to 21

• Residential: children enrolled or

who are eligible to be enrolled in a

San Diego County public school

• Medical: children who are

determined to be medically

eligible

• Financial: none

MEDICAL ELIGIBILITY CRITERIA FOR THE MTP

Two Groups of children are served in

the MTP:

1. Children with neuromuscular,

musculoskeletal, or muscular disease

2. Children under 3 years old without a

clear medical diagnosis but with

symptoms that indicate a high chance

that they may have an eligible diagnosis

in the future

GUIDELINES FOR MTP ELIGIBILITY DETERMINATION

The following slides detail the

criteria that the Therapy

Consultants use when

determining MTP eligibility.

Per Health and Safety Code 100275, 123830, 123835, 41831; 41832 and NL 05-0500

CCS applicants with one of the following conditions shall be medically eligible for participation in the CCS Medical Therapy Program

Cerebral Palsy: a non-progressive motor disorder with onset in early childhood resulting from a non-progressive lesion in the brain manifested by the presence of one or more of the following:

Rigidity or Spasticity

Hypotonia with normal or increased deep tendon reflexes and exaggeration of or persistence of primitive reflexes beyond the normal range

Involuntary movements that are described as athetoid, choreoid, or dystonic

Ataxia, manifested by incoordination of voluntary movement, dysdiadochokinesia, intention tremor, reeling or shaking of the trunk and head, staggering or stumbling and broad-based gait.

Neuromuscular conditions that produce muscle weakness and atrophy, such as poliomyelitis, myasthenias, and muscular dystrophies

Chronic Musculoskeletal and connective tissue diseases or deformities such as osteogenesis imperfecta, arthrogryposis, rheumatoid arthritis, amputations and contractures resulting from burns

Other conditions manifesting the findings listed in #1 above such as ataxias, degenerative neurological disease or other intracranial process, such as traumatic brain injuries.

At Risk Category: CCS applicants under three years of age shall be

eligible when two or more of the following

neurological findings are present: Exaggeration of or persistence of primitive reflexes beyond the

normal age (corrected for prematurity)

Increased deep tendon reflexes (DTR’s) that are 3+ or greater.

Abnormal posturing as characterized by the arms, legs, head, or

trunk turned or twisted into an abnormal position.

Hypotonicity with normal or increased DTR’s in infants below one

year of age. In infants above one year of age must meet criteria

described in (A) (1) (b) above

Asymmetry of neurologic motor findings of trunk or extremities.

The above findings must be from a current

medical report (< 6 mo old) and preferably

from a neurologist since it is most likely

that a neurologist will document the above

findings in the report.

CASE OPENING PROCESS

If child is eligible 3 things are needed prior to case being opened

OT/PT prescription

Signed application by the parent or Court Appointed Legal Guardian (with appropriate documentation)

Current medical report documenting CCS MTP eligible condition.

If an eligible diagnosis is not determined (lack of information/ conflicting medical information), the child is referred to Neurodiagnostic clinic where the child is seen by a

neurologist. This is paid for by CCS. Results will determine if the child eligible Clinic is held monthly at the San Diego South MTU. It is managed and run by the Therapy Consultants

NOT MEDICALLY ELIGIBLE

If a child’s case is not eligible, a Notice of Action (NOA) is issued to the family notifying them of the decision.

The family has a right to appeal any service that has been denied.

An appeal can be filed by the parent. Instructions for an appeal are found on the second page of the NOA

MTP ELIGIBLE

Once eligible the case is sent to

the MTU

Families go through a CCS

orientation

Then PT and/or OT evaluations

are scheduled and performed.

WHAT SERVICES ARE PROVIDED?

Occupational Therapy

Physical Therapy

OUTPATIENT REHAB CENTER CERTIFICATION

All MTUs are certified as Outpatient Rehab Centers (OPRC)

Stringent requirements must be met in order to bill Medi-Cal

Regulations require a current physician exam and

physician signed treatment plan that includes:

diagnosis, prognosis, date of onset, frequency of services,

functional goals and objectives, functional status, and

benefits of previous therapy.

KEYPOINTS ABOUT THERAPY

• Directed towards functional

outcomes

• Based on rehabilitation

principles

• Support to classroom teachers

• Parents are trained & expected

to carry out home programs

PHILOSOPHY OF THERAPY

To assist the child in

obtaining his/her maximum

level of independence in

areas of functional skills

such as mobility,

ambulation , transfers,

feeding, dressing, hygiene,

grooming, toileting and

home skills

THERAPY SERVICES

Level of service is decided by the treating therapist In conjunction with the doctor providing medical direction after full evaluation by all team members Treatment is delivered as infrequently as will result In greatest gain for the individual receiving the services Levels of service include: • Treatment Services and • Monitoring Services • Clinic Only.

ACTIVE TREATMENT

Child is seen 1 time a week or more

Treatment is on a specific functional

goal

Requires a medical report every 6

months

MONITOR TREATMENT

These children are either very functional and don’t require hands on treatment or the child is lower functioning and is not progressing towards specific goals.

- Requires a medical report every 12 months

2 times a month 1 time per month Every 3 months Every 6 months

CLINIC ONLY

Child is not working towards a specific goal but it is necessary to keep case open to the MTU for equipment needs or for orthopedic management.

Child is seen on a as needed basis.

Case remains open as long as the Medical Director deems it necessary

Requires a medical report every 12 months

REASONS FOR CLOSURE TO MTP

Non-Compliance

Does not have a medical eligible

condition anymore

Child does not have specific needs

anymore

Lack of medical direction

Child turns 21

RESOLUTION OF CONFLICT

When a family does not accept the

level of services recommended

there must be resolution

The method used is called

Resolution of Conflict

with an Expert Physician.

RESOLUTION OF CONFLICT

An expert physician is authorized

by CCS to physically examine the

child AND to review the child’s

history of therapy services in

order to make the determination

regarding the child’s medical

therapy needs that are in dispute.

Expert decisions are final and binding

MTU LOCATIONS IN SAN DIEGO

San Diego North at Lindbergh/Schweitzer School

El Cajon MTU at Sevick Educational Center

Vista MTU at California Avenue School

San Diego South MTU at Kimbrough Elementary

Chula Vista MTU at Greg Rogers School West

Escondido MTU at Nicolaysen Center

Poway Satellite- at Los Penasquitos Elementary School

NOW YOU HAVE THE

PIECES...

PUT THEM ALL TOGETHER AND YOU HAVE ...

THE TOTAL PICTURE OF THE...

SLIDE PRESENTATION PREPARED BY:

KERRI MATHESON, MPT

C O U N T Y O F S A N D I E G O

M E D I C A L T H E R A P Y P R O G R A M 2 01 3